According to an article in The New York Times, an estimated 2.5 million Americans were dependent on or abused opioids in 2012. This abuse was mostly in the form of painkillers, although heroin dependence also climbed sharply, with the number of people addicted to heroin actually doubling over a decade to 467,000.
Heroin addiction is an epidemic in the United States, escalating in recent years and creeping into small-town America. Thankfully, there are programs available to help with this potent addiction, and the use of medications are incorporated into many recovery programs.
The use of medications may help with physical withdrawal symptoms, cravings, and both short- and long-term abstinence.
Detoxing from Heroin
Because heroin is such a powerful substance, when people come into treatment, they are often using the drug just to keep from getting sick or experiencing withdrawal symptoms, which can begin 12 hours after last use. Initial withdrawal symptoms include:
- Anxiety
- Muscle aches
- Trouble sleeping
- Runny nose
- Feelings of agitation
- Diffuse sweating
Later symptoms of withdrawal include:
- Nausea
- Vomiting
- Abdominal cramps
- Diarrhea
- Dilated pupils
- Chills
Because these symptoms can be formidable, medications are sometimes used to relieve symptoms during detox to make withdrawal more bearable.
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), in 2011, over 300,000 people seeking help from an opioid addiction received help in the form of medicated detox.
The Treatment Process
Each person is different, and individual needs must be addressed in treatment. This makes it crucial to find a recovery program where treatment includes medical assessment of what drugs, if any, should be used in the treatment process. Generally, the use of medications begin at the first stage of treatment with other modalities introduced as the physical effects of withdrawal become more manageable. However, detox by itself is not considered treatment but only the first step in the journey toward sustained recovery.
A healthcare professional will assess the need for medication in the detox setting and going forward. For detox purposes, medications may be used to minimize withdrawal symptoms as discussed above. Secondly, medications may be employed to assist with cravings and to establish long-term sobriety with opioid agonists (medication that actually blocks the effect of using an opioid such as heroin). In addition, medications may be used to treat co-occurring conditions, such as anxiety, depression, etc., as managing co-occurring issues is often essential to sustaining sobriety.
Medications Used
Certain medications are commonly used in heroin addiction treatment. These include:
- Clonidine: This medication is a generic drug used to treat high blood pressure, but it has also been shown effective in treating opiate withdrawal symptoms, acting as a sedative and reducing many of the initial withdrawal symptoms mentioned above.
- Methadone: This drug is an opioid medication used to treat moderate to severe pain. It has also been used for decades in heroin addiction treatment. Generally, a person is switched off heroin onto methadone, and over time, the dosage is slowly lowered until the person is drug-free. Methadone lessens withdrawal symptoms and decreases cravings for heroin.
- Buprenorphine: This drug is a partial opioid agonist (heroin is a full agonist), meaning it blocks receptors in the brain that would normally be triggered by the use of heroin. At the same time, it may reduce or even eradicate withdrawal symptoms and cravings, as the brain receptors responsible for the high achieved with heroin are led to believe that an encounter with that opiate has taken place. Buprenorphine has gained popularity as an alternative, potentially with less abuse potential, to methadone in opiate addiction treatment.
- Naltrexone: This drug also blocks the ability of an opiate to affect receptors in the brain. It can be beneficial in preventing relapse, though it has little effect on withdrawal symptoms and therefore should not be used during the withdrawal process, but rather as a safeguard against further use of heroin, as it blocks any effect heroin might have. This medication comes in pill form or in an injectable format.
Pros and Cons of Using Medication in Heroin Treatment
There are proponents regarding the use of medications in the detox phase and beyond, and there are those who think using a drug to overcome a drug addiction is not the answer. According to Medline Plus, a person trying to come off heroin, and using medications to aid in that endeavor, could become physically dependent on the new medication, and require more and more of that drug to maintain the initial relief granted, thus forming a new addiction.
In addition, side effects can occur with any medication, but generally, the benefit of use outweighs the side effects that will generally subside over time. WebMD lists common side effects of methadone as:
- Constipation
- Dizziness, lightheadedness, or feeling faint
- Drowsiness
- Nausea or vomiting
It’s important to note, however, that methadone, just like heroin, can be abused. In 2011, it accounted for over 65,000 emergency room visits.
As naltrexone blocks opiates’ effects in the brain, there is a danger of overdose since users may think if they take more of an opiate, they will eventually feel the euphoric effects they felt prior to naltrexone use. This increases the chance of overdose and even death.
Another drawback to using medication to assist with coming off heroin is that participants may feel this is the only treatment they need. They have taken the medication, feel few withdrawal symptoms, and think they are “cured” of their addiction. Medication does not constitute addiction treatment on its own and should only be used in conjunction with therapy. More extensive recovery tools need to be introduced and put in place to achieve and maintain sobriety. Some opponents to medication in addiction treatment fear those seeking recovery may not take the essential additional steps to achieve and maintain recovery.
The Office of National Drug Control Policy points out that there are drug treatment programs, such as methadone clinics, that treat individuals struggling with addiction by giving out medication on a daily basis, but states that their success rates in enabling people to stay sober are not impressive as compared to multi-phased treatment. In addition, one use of heroin during methadone treatment can result in a deadly overdose.
However, using medication to aid in detox, stabilization, and maintenance has its merits. Besides the obvious benefits of helping one through withdrawal, medication can also:
- Open a person up to behavioral treatment methods and further tools to aid in recovery since the person is not suffering as extensively with physical manifestations of ceasing heroin
- Reduce drug-seeking behavior since opiate receptors in the brain are filled
- Increase retention in therapy, thus increasing the odds of obtaining lasting sobriety
In addition to the medications specifically used in heroin addiction treatment, other medications, such as antidepressants or anti-anxiety medications, may be used to address specific withdrawal symptoms or co-occurring mental health issues.
A healthcare provider or substance abuse recovery center will develop a treatment plan based on individual needs that may or may not involve medication assistance.